Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 104100000X | Social Worker | ||
Y | 104100000X | Social Worker | 097491 | NY |
NPI | 1003284373 |
---|---|
Provider Name | Mrs. Brenda Dee Roberson |
First Address | Elmira, NY 14901-3332 |
Second Address | Elmira, NY 14901-3332 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | No |
Is Organization Subpart | N/A |
Enumeration Date | 03/09/2015 |
Last Update Date | 28/04/2016 |